Psychiatric medications, science, marketing, psychiatry in general, and occasionally clinical psychology. Questioning the role of key opinion leaders and the use of "science" to promote commercial ends rather than the needs of people with mental health concerns.

Friday, January 26, 2007

The AHRP blog has a great post on how academics sold out in the case of Paxil/Seroxat. The story includes the text of a likewise great piece from the British Medical Journal on the same topic. On at least one of the Paxil studies authored by "independent" academics, the suicidality of participants magically turned into "lability" and serious aggressive behavior turned into "hostility." The study authors simply renamed the adverse events to sound more tolerable -- I'd certainly rather be "labile" than suicidal, wouldn't you? Here's a link to the abstract of said study so you can see the names of the authors who let this slip by them. Sadly, these are some of the big names in child psychiatry.

According to Joe Collier, Panorama shows how GSK had: "written up" the pediatric Paxil trial for publication; "bought and manipulated (apparently willingly) opinion formers; worked to promote the product for use in children (although it was not, and never has been, licensed for such use);" and how the information about the safety and efficacy of Paxil was distorted in letters to prescribers, in advice to their sales force, and in messages to the media.

6 comments:

What is wrong with the medico-scientific profession? Was ther ever any such thing as scientific integrity, or am I am so naive as to have imagined a time that did not exist? Regardless, of the cause of this ailment, I suspect that the infection as spread far beyond the reach of any self-regulatory immune response. As public and political opinion increasingly [and justifiably] deteriorate, I hope that the ostensible governing professional bodies (AMA, APA, etc.) are not at all astonished when, having sold the good name of a once honorable (and genuinely effective) partnership between medical research and practice piece by piece in pursuit of their o0wn individual and collective self-interest, they find themselves in need of a dramatic intervention.

As a neurochemist-turned-attorney (not trial attorney) who has been studying health care law, economics, and policy for in academic detail for the past 6 years, I am sadly aware of our system . . . where approx. 18,000 deaths per year are directly attributable to the lack of health insurance yet at least 5x as many die because of medicine itself in the form of preventable medical errors . . . where autopsy studies reveal a 40% of misdiagnosis in terminal patients (1/3 of which could have have prevented death if corrected) . . . more importantly a system where that same error rate has not improved since 1938 . . . MRI's, CT Scans, advanced diagnostics, and no improvement.

What we have is not medical science . . . it is shamanism and snakeoil. We have a profession that seems allergic to basic empiricism, but one where any profitable practice is allowed to propagate on plausibility and the placebo effect alone (HRT, SSRI's, etc.). Everyone-and-their-mother seems to have a healthcare reform proposal right now, but before we begin to talk about how to get more money to pay for health care we need to ask what the hell are we paying for, why are we paying for it, is it effective (or even harmful), and most importantly, how do we know the answer to any of these questions?

Given that we all accept and understand the inherent variability in the effect of trauma, disease, and treatment on the human body, what system do we have to analyze and refine our practices and knowledge?

Should we have faith in a system where we have a radiology tech, who randomly notices the heart problems caused by fen-phen, and determined whistleblowers, such as David Graham, have to fight tooth and nail to get everyone else to notice what should have been obvious?

To wrap up my ventingon a positive note, I will admit that I do find your seatbelt comment a nice segue, medicine does do a great job and shows much improvement in preventing death from trauma.

Unless I have been shot or in a wreck, I would rather stay as far away from a hospital as possible.

nab, I have come to believe that academic medicine has social structure that is very similar to that of South Central LA, except that the cabals don't call themselves the crips and the bloods, but perhaps the shrinks and the hematologists.

You could even extend the analogy further. Who would be the cops (that both could fight with)? Insurance companies? The South American cartels could be the Big Pharma and the device makers. . .with the gangs fighting over who gets the best cut off their "product" . . . okay I must stop . . .too sad. . .too easy.

Organizations

Scientific Misconduct

About Me

I'm an academic with a respectable amount of clinical experience and no drug industry funding. Given my lack of time, don't expect multiple daily updates. Certain things about clinical psychology, the drug industry, psychiatry, and academics drive me nuts, and you'll probably pick up on these pet peeves before long...